public health

An article in NEJM Catalyst looks at how to better coordinate the functions of public health officials and private-sector health systems. The authors write:

“Moving toward a comprehensive community wellness vision requires a fundamental transformation of how healthcare and public health engage with one another. Previously siloed organizations may find they have duplicative efforts that are ripe to be streamlined. For example, we reviewed cases where local health department funding to address certain public health objectives was made dependent on performing a certain service (e.g., reproductive health counseling), even if the local healthcare system was already efficiently and effectively providing that service for the same population. Rather than reject the funding from the state or federal government, local public health was compelled to implement a duplicative service. A structured partnership that arranges consolidation of these repeat programs could free limited resources within a community to be redirected to other health needs.

1802 caricature of Edward Jenner vaccinating patients who feared it would make them sprout cowlike appendages.

A new blueprint is needed to guide U.S. public health, focusing on food and housing security, good schools and transportation, as well as directly on medical care and illness and injury prevention, wrote Karen DeSalvo, acting assistant secretary for health at the Department of Health & Human Services, and Georges Benjamin, executive director of the American Public Health Association, in Health Affairs.

In other words, run American public health services more as governments do in the many other developed nations, in Western Europe and East Asia, that have far better health outcomes than does the U.S.

“Public Health 3.0” sees public health leaders as chief health strategists for their communities, in which there would be many cross-sector partnerships, including employers, insurers, education leaders and other stakeholders.

The blueprint would build on such earlier public health efforts as mass vaccinations, antibiotics, laboratory science, food and water safety and the professionalization and standardization of public health agencies.

“We must address the upstream drivers of health that touch everyone, no matter where they are born, live, learn, work, play, worship and age,” the authors wrote. “Public health is the essential infrastructure for this work, but it needs to innovate, and in many ways, reinvent itself so that we have what it takes to ensure that the American people are healthy, ready, and competitive in this global economy.”

Giving urgency to their proposals is that after decades of life expectancy growing in the U.S., average levels have been flat over the past three years and have actually dropped in some areas.

“Cross-sector partnerships to improve public health are already occurring across the country. ‘The traditional ‘silos’ of medical, behavioral and social services can’t meet the needs of our population alone,’’ Jim Hickman, CEO of Better Health East Bay, in California, told Healthcare Dive recently. “Partnerships, enabled by technology and amplified by data-sharing, are the first step in changing the way we deliver care.”

Other Public Health 3.0 blueprint steps include ensuring that all public health departments are nationally accredited, thus providing communities with “timely, reliable, granular-level … and actionable data,’’ establishing metrics to measure public health programs’ success and more flexible and sustainable funding sources.

Ronald Bayer, Ph.D., and Sandro Galea, M.D., both of the Columbia University Mailman School of Public Health, argue in The New England Journal of Medicine that the federal government and the healthcare industry’s focus on personalized medicine could hurt efforts to improve population health.

They argue that precision medicine advocates’ focus on treatment at the individual level means that they tend to ignore such pressing concerns as the United States’ low ranking among developed nations in care quality or socio-economic factors’ (aka the “social determinants of health”) big effect on mortality.

The authors say that the Feds have invested about five times more in National Institutes of Health research, increasingly focused on individualized-care models, than in the Centers for Disease Control and Prevention. And, they write, the proportion of NIH-funded initiatives with “population” or “public” in their names fell 90 percent in the last decade.

“Without minimizing the possible gains to clinical care from greater realization of precision medicine’s promise, we worry that an unstinting focus on precision medicine by trusted spokespeople for health is a mistake — and a distraction from the goal of producing a healthier population.”